Unveiling Drug Company Bribes in Subsys Prescriptions

Too many drug companies have paid doctors and nurses to inappropriately prescribe their drugs. A couple of times a year we see the headlines and the multimillion dollar settlements that drug companies pay. But what about the medical professionals who take those bribes and write those prescriptions? Heather Alfonso pleaded guilty to taking those bribes. She’s an APRN (advanced practice registered nurse) which allowed her to write prescriptions when she worked at a pain clinic in CT. FiercePharma reported: Last year, script numbers showed that half of Subsys prescriptions were being written not by oncologists or pain specialists — as the FDA had directed — but by other types of providers, including GPs and dentists.

Subsys is a form of fentanyl — a highly restricted painkiller approved only for use in cancer patients. The US Attorney’s office reports that Alfonso was the highest prescriber of the drug in CT and interviews with several of Alfonso’s patients, who are Medicare Part D beneficiaries and who were prescribed the drug, revealed that most of them did not have cancer, but were taking the drug to treat chronic pain. Subsys is highly addictive. Alfonso knowingly prescribed it to people who she is sworn and trained to help. Instead she harmed them and took money for it.

The Office of Inspector General (OIG, part of Health and Human Services) is actively investigating doctors’ roles in kickback schemes. The OIG issued a fraud alert to medical practices in early June warning physicians that compensation agreements must reflect fair market value. In the alert, the OIG announced they recently reached settlements with 12 individual physicians who entered into questionable medical directorship and office staff arrangements that included payments from pharmaceutical companies.

Alfonso has pled guilty and presumably will testify against Insys Therapeutics, the makers of Subsys. Despite her testimony, her crime is ethically repugnant and I hope she is prosecuted the full extent of the law. Further, I hope her patients are offered real treatment for pain if needed and a lifetime of rehab support, which many will need due in part to her actions.

Alfonso’s actions took place while she was an employee of a company. Why are not the employees of a pharmaceutical company similarly at risk for jail time? I hope the company, Insys Therapeutics, is fined out of existence and that the president of Insys Therapeutics join the nurse behind bars.

There are bad apples in every profession and doctors are no exception. But their ability to cause harm and the trust that our community places in doctors holds them to a high standard. We must actively ferret out those who cannot live up to the standard. In that way. drug companies (whose management should also be personally prosecuted) will  have a more difficult time bribing our trusted health care professionals.

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